Department of Pharmacy, Peking University Third Hospital, Beijing, China.
Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.
Front Public Health. 2023 May 9;11:1159119. doi: 10.3389/fpubh.2023.1159119. eCollection 2023.
BACKGROUND: In April 2009, the Chinese government launched Zero Markup Drug Policy (ZMDP) to adjust medical institutions' revenue and expenditure structures. OBJECTIVE: This study evaluated the impact of implementing ZMDP (as an intervention) on the drug costs for managing Parkinson's disease (PD) and its complications from the healthcare providers' perspective. METHODS: The drug costs for managing PD and its complications per outpatient visit or inpatient stay were estimated using electronic health data from a tertiary hospital in China from January 2016 to August 2018. An interrupted time series analysis was conducted to evaluate the immediate change following the intervention (step change, β) and the change in slope, comparing post-intervention with the pre-intervention period (trend change, β). Subgroup analyses were conducted in outpatients within the strata of age, patients with or without health insurance, and whether drugs were listed in the national Essential Medicine List (EML). RESULTS: Overall, 18,158 outpatient visits and 366 inpatient stays were included. Outpatient (β = -201.7, 95%CI: -285.4, -117.9) and inpatient (β = -372.1, 95% CI: -643.6, -100.6) drug costs for managing PD significantly decreased when implementing ZMDP. However, for outpatients without health insurance, the trend change in drug costs for managing PD (β = 16.8, 95% CI: 8.0, 25.6) or PD complications (β = 12.6, 95% CI: 5.5, 19.7) significantly increased. Trend changes in outpatient drug costs for managing PD differed when stratifying drugs listed in EML (β = -1.4, 95% CI: -2.6, -0.2) or not (β = 6.3, 95%CI: 2.0, 10.7). Trend changes of outpatient drug costs for managing PD complications significantly increased in drugs listed in EML (β = 14.7, 95% CI 9.2, 20.3), patients without health insurance (β = 12.6, 95% CI 5.5, 19.7), and age under 65 (β = 24.3, 95% CI 17.3, 31.4). CONCLUSIONS: Drug costs for managing PD and its complications significantly decreased when implementing ZMDP. However, the trend in drug costs increased significantly in several subgroups, which may offset the decrease at the implementation.
背景：2009 年 4 月，中国政府推出零加成药物政策（ZMDP），以调整医疗机构的收支结构。
目的：本研究从医疗服务提供者的角度评估实施 ZMDP（作为干预措施）对管理帕金森病（PD）及其并发症的药物成本的影响。
方法：使用中国一家三级医院的电子健康数据，估算了 2016 年 1 月至 2018 年 8 月期间，每例门诊或住院患者管理 PD 及其并发症的药物成本。采用中断时间序列分析评估干预后的即时变化（阶跃变化，β）和干预后与干预前期间的斜率变化（趋势变化，β）。在年龄、是否有医疗保险、药物是否列入国家基本药物目录（EML）的亚组中进行了门诊患者的亚组分析。
结果：共纳入 18158 例门诊和 366 例住院患者。实施 ZMDP 后，门诊（β = -201.7，95%CI：-285.4，-117.9）和住院（β = -372.1，95%CI：-643.6，-100.6）管理 PD 的药物成本显著降低。然而，对于没有医疗保险的门诊患者，管理 PD（β = 16.8，95%CI：8.0，25.6）或 PD 并发症（β = 12.6，95%CI：5.5，19.7）的药物成本趋势变化显著增加。当分层列入 EML 的药物（β = -1.4，95%CI：-2.6，-0.2）或未列入 EML 的药物（β = 6.3，95%CI：2.0，10.7）时，门诊管理 PD 的药物成本趋势变化不同。列入 EML 的药物（β = 14.7，95%CI 9.2，20.3）、无医疗保险患者（β = 12.6，95%CI 5.5，19.7）和 65 岁以下患者（β = 24.3，95%CI 17.3，31.4）管理 PD 并发症的药物成本趋势变化显著增加。
结论：实施 ZMDP 后，管理 PD 和其并发症的药物成本显著降低。然而，在几个亚组中，药物成本的趋势显著增加，这可能抵消了实施时的减少。
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